Managing Diabetes During Pregnancy

Almost two million women of reproductive age have diabetes, and these numbers continue to rise, according to the Centers for Disease Control and Prevention.

It is extremely important for women with diabetes to achieve normal blood glucose levels before they become pregnant, because if women have poorly controlled diabetes going into a pregnancy, they are at much higher risk for serious fetal complications. This improved control can be accomplished with education and medical management.

Women with type 1 diabetes or type 2 diabetes are also at higher risk for:

Large birth weight babies, resulting in more Cesarean deliveries and increased complications during delivery

Premature births or fetal death

Pre-eclampsia: a dangerous surge in blood pressure associated with protein in the urine

Diabetic retinopathy: damage to the retina caused by high glucose levels

Diabetic kidney disease

Severe hypoglycemia: episodes of low blood glucose levels that can result in confusion or unconsciousness

Ensuring a healthy pregnancy

The good news is that women with uncomplicated diabetes who keep their blood glucose levels in a normal range before and during pregnancy have about the same chance of having a successful pregnancy as women without diabetes.

The Joslin-Beth Israel Deaconess Pregnancy Program recommends the following blood glucose goals and medical assessments before pregnancy:

Fasting and pre-meal blood glucose: 80-110 mg/dl

Blood glucose one hour after meal: 100-155 mg/dl

A1C, a blood test that measures average blood glucose over two to three months: less than 7 percent and as close to 6% as possible without hypoglycemia

Review of diabetes and obstetrical history

Eye evaluations to screen for and discuss risks of diabetic retinopathy

Renal, thyroid, gynecological and sometimes cardiac evaluations

Once pregnant, women with type 1 or type 2 diabetres should monitor their blood glucose levels at least six times a day (before meals and one hour after every meal) and also before driving. Fasting and pre-meal glucose levels should be between 60 and 95 mg/dl, and one-hour post-meal readings should be between 100 and 129 mg/dl.

Other recommendations to ensure a successful pregnancy:

See your diabetes provider often, anywhere from weekly to every four weeks

Have your A1C level checked every four to eight weeks

Meet with a certified diabetes educator and registered dietitian, as needed

Gestational diabetes

The other form of diabetes that affects women is gestational diabetes, which develops during pregnancy. Mirroring the epidemic of type 2 diabetes, rates of gestational diabetes are also on the rise in the United States, particularly in the Asian, Hispanic and Native American communities.

Gestational diabetes usually develops between the 24th and 28th week of pregnancy and affects about four percent of all pregnancies. This condition typically ends after birth. However, these women have a 50 percent risk of developing type 2 diabetes over the next 7 to 10 years.

Factors that increase a woman’s risk of developing gestational diabetes:

Obesity

Previous history of gestational diabetes

Sugar in the urine

A parent or sibling with diabetes

Polycystic ovary syndrome or other glucose metabolism problem

Previous pregnancy in which the baby weighed more than nine pounds at birth

If you fall into any of these categories, you should be screened early, within the first trimester, for gestational diabetes. Women who find out that they have gestational diabetes should see a nutritionist and diabetes nurse educator, as diet is the first line of therapy.

With careful diabetes management, women can and do have successful pregnancies and healthy babies.

For more information about the Joslin-Beth Israel Pregnancy Program, or to make an appointment, please call 617-732-2496.